In his book, “The Depression Cure: The 6-Step Program to Beat Depression without Drugs,” author Stephen Ilardi argues that the rate of depression among Americans is roughly ten times higher today than it was just two generations ago, and he points the blame to our modern life-style. Everything is so much easier today than it was back when we had to hunt and gather. Why doesn’t the convenience translate into happiness?
His book concentrates on six ways we’ve turned our back on the things that fight depression. I concur with him that the modern lifestyles contributes to the rise of depression, and I wholeheartedly support all six steps he offers. In fact, each one is included in my 12-step program for beating depression. However, I am uncomfortable with his dismissal of medication, because that is such an important part of my program. He agrees that for those battling severe depression, antidepressants are effective, and claims that individuals suffering from bipolar disorder derive unequivocal benefit from mood stabilizers. But he thinks that the majority of those suffering from unipolar depression can get better on their own.
I guess I’m a tad skeptical because I tried that route. Even though I had implemented all six of his steps into my recovery program, I didn’t get well until I found the right medication combination–which included two antidepressants in addition to a mood stabilizer–to treat my bipolar disorder; that is, until I was stable enough to continue all the exercises needed to get and stay well. And the mood stabilizer by itself was not enough to bring me out of a suicidal depression.
I want to highlight his six steps, however, because I do think they are crucial to a recovery program from depression, and I congratulate him on such a comprehensive book.
1. Omega-3 Fatty Acids
Yes. Absolutely. I get a Noah’s Ark shipment of those to my house every month, as I have read the same research. Ilardi writes:
Because the brain needs a steady supply of omega-3s to function properly, people who don’t eat enough of these fats are at increased risk for many forms of mental illness, including depression. Across the globe, countries with the highest level of omega-3 consumption typically have the lowest rates of depression.
Clinical researchers have even started using omega-3 supplements to treat depression, and the results so far have been highly encouraging. For example, British researchers recently studied a group of depressed patients who had failed to recover after taking antidepressant medication for eight weeks. All study patients stayed on their meds as prescribed, but some also took an omega-3 supplement. About 70 percent of those who received the supplement went on to recover, compared with only 25 percent of patients who kept taking only the medication. This study–along with a handful of others like it–suggests that omega-3s may be among the most effective antidepressant substances ever discovered.
2. Engaged Activity
According to Ilardi, engaged activity keeps us from ruminating, and ruminating causes depression. I understand his logic, and he is right that we are more isolated now in our lifestyle than even 10 years ago because technology allows us to do our jobs individually. Says Ilardi:
The biggest risk factor for rumination is simply spending time alone, something Americans now do all the time. When you’re interacting with another person, your mind just doesn’t have a chance to dwell on repetitive negative thoughts. But, really, any sort of engaged activity can work to interrupt rumination. It can even be something simple.
3. Physical Exercise
You all know where I stand on exercise: it’s essential. At least for this brain. I can’t go two or three days without feeling the effect of no exercise. I’ve cited much of the same research as Ilardi in past posts. But here’s a reminder. Ilardi writes:
Researchers have compared aerobic exercise and Zoloft head to head in the treatment of depression. Even at a low “dose” of exercise–thirty minutes of brisk walking three times a week–patients who worked out did just as well as those who took the medication. Strikingly, though, the patients on Zoloft were about three times more likely than exercisers to become depressed again over a ten-month follow-up period.
There are now over a hundred published studies documenting the antidepressant effects of exercise. Activities as varied as walking, biking, jogging, and weight lifting have all been found to be effective. It’s also becoming clear just how they work. Exercise changes the brain. It increases the activity level of important brain chemicals such as dopamine and serotonin (the same neurochemical targeted by popular drugs like Zoloft, Prozac, and Lexapro). Exercise also increases the brain’s production of a key growth hormone called BDNF. Because levels of this hormone plummet in depression, some parts of the brain start to shrink over time, and learning and memory are impaired. But exercise reverses this trend, protecting the brain in a way nothing else can.
4. Sunlight Exposure
Says Ilardi:
A deeper link exists between light exposure and depression–one involving the body’s internal clock. The brain gauges the amount of light you get each day, and it uses that information to reset your body clock. Without light exposure, the body clock eventually gets out of sync, and when that happens, it throws off important circadian rhythms that regulate energy, sleep, appetite, and hormone levels. The disruption of these important biological rhythms can, in turn, trigger clinical depression.
Because natural sunlight is so much brighter than indoor lighting–over a hundred times brighter, on average–a half hour of sunlight is enough to reset your body clock. Even the natural light of a gray, cloudy day is several times brighter than the inside of most people’s houses, and a few hours of exposure provide just enough light to keep circadian rhythms well regulated.
5. Social Support
I can’t count the number of studies I’ve read indicating the importance of social support. Recently Rick Nauert posted the results of a recent University of Michigan study on how gossip does us good. University of Michigan researcher and lead author of the study, Stephanie Brown, said: “Many of the hormones involved in bonding and helping behavior lead to reductions in stress and anxiety in both humans and other animals. Now we see that higher levels of progesterone may be part of the underlying physiological basis for these effects.”
Ilardi writes:
The research on this issue is clear: When it comes to depression, relationships matter. People who lack a supportive social network face an increased risk of becoming depressed, and of remaining depressed once an episode strikes. Fortunately, we can do a great deal to improve the quality and depth of our connections with other and this can have a huge payoff in terms of fighting depression and reducing the risk of recurrence.
6. Sleep
Again, amen! Per Ilardi:
When sleep deprivation continues for days or weeks at a time, it can interfere with our ability to think clearly. It can even bring about serious health consequences. Disrupted sleep is one of the most potent triggers of depression, and there’s evidence that most episodes of mood disorder are preceded by at least several weeks of subpar slumber.
(11 votes, average: 3.82 out of 5)
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Links to This Article
6 Steps for Beating Depression | World of Psychology | Get out of your Depression Rut! (7/10/2009)
Stephen Ilardi : News, pictures, videos, biography (7/19/2009)
Find a Natural Remedy for Depression | Alternative Medicine (7/20/2009)
treatment of depression (10/12/2009)
10 Comments to
“6 Steps for Beating Depression”
Thanks for the review, Therese.
I do have one point of clarification, however. Although the published evidence suggests that the majority of those suffering from major depressive disorder (unipolar depression) fall into the mild-to-moderate category of individuals who gain no significant advantage of meds vis-a-vis other forms of efficacious treatment (exercise, behavioral activation, phototherapy, etc), I state very clearly in Chapter 11 of the book that individuals suffering from BIPOLAR disorder derive unequivocal benefit from mood stabilizing medications. Thus, I do not believe it’s fair to generalize from your experience of bipolar illness to that of those suffering from unipolar depression, nor does it appear that you’ve accurately characterized my own position on this matter.
Otherwise, I loved the review!
Best wishes,
Steve Ilardi, Ph.D.
University of Kansas
It really is an interesting subject, and indicates that the times have changed dramatically, and now the depression is much stronger than before, is also the lifestyle that we lived for two generations, very different indeed, as to the antidepressants should be very careful as they can be very dangerous if not performed adequately, because we have many cases where people have come to impair their lives by these drugs (as findrxonline, trusted source, and there are more than thousand cases in United States) it is required to be very careful and take an appropriate and prescribed by the doctor, never self that is much more dangerous still.
I posted a Tweet about this article today.
“Feeling depressed? For deep sadness or real depression, here’s 6 simple things you can do to help. http://bit.ly/pllDl”
I also blogged about “lying to your doctor”. Excellent topic.
My focus is on tools for medication compliance. Maybe we can team up to help people. Contact me on my website.
We are in a very interesting place with regard to research on effective treatments for depression. I applaud the approach that Ilardi has taken in breaking a treatment package into manageable chunks. However it seems that a fundamental componant of effective treatment may have been overlooked in the process. I have been conducting trials, over the past 3 years in the UK, with the computerized CBT package Blues Begone http://www.bluesbegone.co.uk. I have accumulated a vast data set on the ability of self help to provide a very powerful intervention. Blues Begone focuses on the combination of behavioural activation, and in that we have common ground with Ilardi, but it also devotes a huge quatity of resources to helping people learn to challenge unhelpful, wrong and negative thinking. This combined approach yeilds a 60% cure rate in clinically depressed individuals and a 50% cure rate in clinically anxious individuals. From properly controlled medical trials we can state with certainty that our combined cognitive and behavioural approach gives a clinical effect equal to 12 hours of face to face CBT therapy. We are left with the conclusion that ordinary people, if given the proper resources and helped to use them, can adequately and successfully treat and cure themselves of depression. This may heralds a revolution in the treatment of common mental health problems. And perhaps may signal the beginning of a reveral in the trend of increasing disability caused by dpression and anxiety disorders.
I’m in complete agreement with Therese’s review. When I first heard of this book, it was during a radio interview with the author. I got a little nervous listening to his skepticism on medication. Much of the ineffectiveness of antidepressants are due to the inconsistent regimen of the patient. And I’m sure the increase in depression has a lot to do with the increase of diagnosis in general. The Amish don’t experience depression as much? Well, the Amish tend to not seek psychotherapy for their symptoms either. I have no evidence to support this - it’s just a hunch. I have suffered from depression my entire adult life, and hopefully soon, I can be rid of the cocktail of pills - once I learn how to feel better on my own. But this is the eternal confusing crisis of depression. How much do I actually have control of?
Hey Dr. Ilardi! How nice to see you’ve commented. Your statistics on the ineffectiveness of antidepressants made me very nervous. Moreover, your description of what suicidal thoughts actually were made me very, very nervous. I always thought suicide was a wish for death, therefore I never saw myself in that category. I was terrified at the description, because I realized the mental anguish you described was what I was experiencing. I’m inspired, mostly by fear, hehe, to get better. Believe me, this is big. I haven’t felt inspired by much in a long, long time. I need to change how I live, and not rely so much on the medication. But I really do need it and I can’t ever see not needing it. Any thoughts?
I think that people who have a lot of external issues, and by that I mean, that they are concerned about feeding their family, and surviving, and keeping safe and warm, have less internal issues, including ‘mental illness’ and Depression as well.
On the other hand, people who have a lot of money, and they are not struggling on the external, or at least are not totally busy with outside stuff, they have more internal problems, and issues.
Having too much is terribly stressful and depressing, in fact. So is too much freedom. So is when you think that life is all about waking up happy every morning, and you make this somehow your goal or purpose in life.
“Oh, I must be ill, because I was not happy today”
Imagine if before you did anything, fun or tedious, a party or a chore or a walk, or getting the mail, that you had to climb over a huge heap of garbage. Imagine that heap of garbage was as big as a house - not impossible to climb over - but a huge pain in the a%$ nonetheless. That party, or walk, or fun thing would not seem as fun to do anymore. Maybe not worth it, and if it was still worth it, it would be hard to do. That chore is that much harder to do. Might make everything seem like a chore.
And work. You’d still get to work on time, but that huge heap of garbage makes it more work, so difficult to get going. And then despair and frustration over how difficult it all is. THAT’s depression. Depression is not simply unhappiness. It’s almost paralysis.
I know, Sara. I have been there. Just paralyzed.
I used to have this aunt, a psychologist, who, whenever she saw me, would urge me to go swimming, and she would insist that this was what I needed to get out of my depression.
I told her to just let me be, and that it was OK, and she did not have to do anything, or try and change me. Then she would say that she just can’t stand looking at me, and that became a problem, not being allowed to even exist without a happy ’swimmer’s face’.
Then she would get mad that I never visited, and go on and on about my needing to swim.
I am sure you know what I mean. She’s actually still my aunt but has moved to a city a little further away…thank God. (and I never said anything, or complained, or whined, or anything)
Very interesting!!
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Last reviewed: By John M. Grohol, Psy.D. on 10 Jul 2009
